The discussion came less than a week after Gov. Peter Shumlin, citing delays and technical problems with the Vermont Health Connect website, announced that Vermonters had the option of extending their current coverage through March 31, three months longer than the previous deadline for purchasing coverage through the exchange. The changes also allow businesses the additional option of enrolling in the exchange directly through Blue Cross and MVP.

In a release on the changes, Shumlin expressed frustration with the technical problems. “No one has been more frustrated and angry than me about the pace of progress in enabling Vermonters to choose and sign up for affordable, quality health coverage. The most important step we can take immediately is to ensure the system is fully operable as quickly as possible,” the governor said. “While I am confident that Vermont Health Connect will be a success and we will get past this temporary transition, I will not let uncertainty on this front drag on.”

At Monday evening’s forum, Vermont Health Access Policy and Planning Chief Cassandra Gekas said details of the new rules announced last week are still being worked out in Montpelier. Wilmington resident Beth Greene asked how deductibles – those for this year and for next – would be affected by the change. Gekas said that was one of the things that was still under discussion. “There’s talk of extending plans and if your deductible is already met, you’ll keep it. There’s also talk about prorating (new 2014) plans.”

Green Mountain Care Board member Dr. Karen Hein told the crowd that the new health insurance system is intended to bring down costs in Vermont. She noted that some consumers – those who have been purchasing inexpensive policies with minimal coverage – will pay more than they have in the past. “Vermonters are paying pretty much the highest amount of anyone in the country for health care,” she said. “About $8,000 per person annually. We’re also one of the healthiest states, and we’re about the oldest state in the nation. The number one cause of personal bankruptcy is medical costs. We’ve got to do something about the parts of the system that are not working for Vermonters.”

Hein said one of the reasons for the high cost of health care is the high number of Vermonters who aren’t currently covered. Under the Affordable Care Act, many more will be covered. “We need to bring the uninsured into the system,” she said. “We’re all paying when the uninsured go to the emergency room. Some Medicare costs are not covered. That cost is shifted onto the people with self-paid or commercial insurance.”

Vermont has high quality health care, Hein said, and under the new insurance system “you can actually get it.”

Hein said the Green Mountain Care Board is an independent board that represents Vermonters. One of their chief tasks is to set health insurance rates on the exchange. Responding to a question, Hein said that it was the board’s goal to set rates that ensure the solvency of participating insurance companies, without overburdening consumers.

One of the ways the board seeks to keep costs down is to work toward reducing incentives for “overtreatment,” which she said accounts for as much as one-third of health care costs. Overtreatment, she said, includes unnecessary or duplicate tests, as well as outdated treatment methods.

Hein, who lives in Whitingham and is the Green Mountain Care Board’s only member from southern Vermont, urged the public to contact the board in writing with concerns they have. “Our job is to implement the law. There are five of us. We’re the regulators, and we’re here to serve you.” She said the board will continue to “ratchet rates down.”

Gekas described Vermont Health Connect as an online marketplace where Vermonters can compare plans side-by-side, and enroll online. Vermont’s law, she said, is in compliance with the federal Affordable Care Act, which includes consumer protections that went into effect when the law was passed, as well as minimum coverage requirements that go into effect with the new health care exchanges – although Vermonters have had many of the requirements since before the ACA.

While Vermonters have had many of the benefits of the ACA since before the law was passed, including coverage for pre-existing conditions, some ACA requirements such as the blanket limit on out-of-pocket expenses ($6,500 for individuals, $12,700 for families) may be new for some Vermonters. Gegas said new regulations also require certain preventive care at no out-of-pocket cost.

Under the optional federal Medicaid expansion that accompanied the ACA, another 32,000 low-income Vermonters will be covered, Gekas said.

Gekas said the rollout of the Vermont Health Connect website has been “bumpier than we would have like.” She said people have been using the site and enrolling in plans. “Our goal is to have 70,000 people enrolled by March 31,” she said.

The biggest change for most consumers will be the number of choices – Vermonters who are used to a choice of one or two plans offered by their employers will now have to compare and choose from as many as 20 plans. And evaluating insurance benefits and needs may be new to most consumers. “The base of all the plans is the same,” Gekas said, referring to the basic requirement for each plan under the new law. “It frees you up to think about what fits for you. If you’re younger and healthier, you might choose a bronze (higher deductible) plan. If you need a lot of medical care, or have significant prescription needs, you might need a plan that costs more, but means less out-of-pocket when you see the doctor.”

To help individuals choose the best plan for them, the state has funded “navigators,” people versed in the choices offered under the plans as well as the state and federal subsidies that are available for Vermonters based on income.

Gekas said a variety of medicine is covered, including naturopathic and chiropractic, under the plans. But Wilmington chiropractor Michelle Doucette expressed disappointment that the least expensive catastrophic care plans were available only to young Vermonters. “I’d like to see that extended to adults who are healthy, have worked all their lives to stay healthy, and have avoided allopathic health care. There are a lot of healthy people who have spent their money to stay healthy, using their resources for healthy behaviour.”

Gekas said a change in the requirements wasn’t in the cards for now, but said that the system could evolve based on the needs of Vermonters. “We’re going to have to continue this discussion for many years, and lot of this is health debate. A lot of what’s happening now is driven by the feds.”

Aimee Reed asked about the role of small business in health care. Gekas said businesses must decide if they’re going to offer coverage, whether they’re going to offer it for individuals or families, and if they decide to provide an amount for insurance, they must choose an amount they’ll provide.

Navigator Anissa Lewis said she’s been working with small businesses to help them decide whether it’s in the best interest of their employees to offer any employer match at all. “Depending on their income, if you offer insurance to your employees that stops them from being eligible for the premium subsidy,” she said. “Some businesses we’ve worked found their employees are better off if they didn’t offer a (premium match).”

“I’ve had businesses that said they feel terrible, because they want to take care of their employees, but we tell them that they may be taking better care of their employees by allowing them to go into the exchange and get the subsidy,” added navigator Joan Bowman.

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